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Opinion: Definition of elective surgery remains a gray area

All elective procedures in Ohio were cancelled to conserve personal protective equipment (PPE) for fighting the COVID-19 pandemic.(Photo: Deseret News)

She just had to make it to next week. She had the date circled on her calendar. She knew she would be able to turn over in bed without agonizing pain. She could attempt to brush her teeth without fear of sharp, searing pain down her leg. If she was lucky, she would be able to play with her grandchildren again.

She woke up with agonizing back pain just a few weeks ago. She didn’t know what she did to bring it on. She knew she had not taken a fall recently or lifted anything heavy. She couldn’t make her bed or put on her shoes without suffering from severe back pain. As she looked around her house, she knew she couldn’t run the sweeper. She loved to garden and with spring here, she wasn’t sure if she would be able to tolerate bending forward. She exhausted her acetaminophen tablets and tried all of the creams and patches she could find in the local pharmacy. Even with all these creams and patches, she couldn’t control her pain.

She was scheduled for an injection in her back, but after March 18 all elective procedures in Ohio were cancelled to conserve personal protective equipment (PPE) for fighting the COVID-19 pandemic. When she got the call cancelling the procedure, she was beside herself. She heard the stories about how terrible the virus was. It just didn’t feel "elective" to her.

She came into my office distraught.

"How long would I have pain? How long until I can feel better? What can I take in the meantime? How long until this is over?"

She had more questions than I had answers. She knew certain things she just didn’t want to do. She read all the articles about the opioid crisis and the despair this caused. She wanted to avoid any addictive medications.

10. Back pain &nbsp; &nbsp; Back pain may develop in women with ovarian cancer due to fluid buildup in the pelvic area, especially if the uterus is tipped backwards, according to Dr. Tarricone. In this case, the ovaries sit behind the uterus and any enlargement, such as tumors growing, will put pressure on the nerves in the pelvis and in the back, causing pain, he explained. Fluid buildup in the pelvis can also cause back pain. ALSO READ: 25 Health Symptoms People Always Ignore but Never Should(Photo: Rawpixel / Getty Images)

We talked about her options until the pandemic turned around. We looked at the best exercises to help her. We talked about options like meditation and deep breathing to help calm her when she felt overwhelmed. We limited her acetaminophen and started her on a course of medications to help with her sharp, shooting leg pain and her daily, dull, achy pain.

I could see her forehead wrinkles relax somewhat, but I still felt the palpable anxiety. She agreed we would check on her progress in two weeks.

The definition of an elective surgery or procedure remains a gray area. The Ohio Department of Health (ODH) defined an elective or nonessential procedure as "a procedure that can be delayed without undue risk to the current or future health of the patient." The ODH went on to cite some examples of essential surgeries: as a threat to the patient’s life if surgery or a procedure is not performed, threat of permanent dysfunction of an extremity or organ system, risk of rapidly worsening to severe symptoms.

This terrible pandemic has already overwhelmed us and devastated countless lives. In preparing for the peak, preserving PPE is essential. As a physician, prioritizing patients is a horrible conundrum.

Dr. Aarti Singla is a pain management physician and partner at Wellington Orthopaedic & Sports Medicine. She is dual board-certified in Physical Medicine & Rehabilitation and Pain Medicine and an integral member of the Wellington Spine team. She can be reached at info@aartisinglamd.com.